Left atrial appendage device closure is preserved for patients with history of atrial fibrillation and a bleeding event or with predisposition for bleeding. These individuals would usually need anticoagulation to avoid intracadiac clot formation but are on high bleeding risk at the same time. This innovative procedure is done to prevent patients suffering with atrial fibrillation or paroxysmal atrial fibrillation from clot formation in the heart and subsequent embolism. It also dissolves the need for anticoagulation therapy and therefore reduces the risk of bleeding in the patient.
After implantation of the device they just need long-term aspirin therapy but no anticoagulation anymore and are therefore protected from both, bleeding and embolism.
What is a left atrial appendage?
The left atrial appendage is something like a “cecum of the heart”. It varies in size and originates from the left atrium which is one of the left sided heart cavities.
Why does it matter?
In patients with atrial fibrillation what is a common arrhythmia, blood flow inside the left atrial appendage is significantly reduced potentially causing clot formation in the appendage. These clots are prone to embolism and subsequent stroke.
Why not taking meds to avoid it?
Indeed, long-term anticoagulation is effective to avoid clot formation and embolic stroke. However, those individuals who already have experienced a bleeding event or have predisposition for the same are deemed on high bleeding risk when taking anticoagulants.
Who benefits from left atrial appendage device closure and what are the benefits?
Those individuals who have chronic or paroxysmal atrial fibrillation on the one hand and are on high bleeding risk on the other hand, benefit most from the procedure. Permanent closure of the appendage prevents the patient from clot formation and subsequent embolism without taking anticoagulants. Instead, the patients just need to take aspirin which is associated with a much smaller bleeding risk compared to anticoagulants.
How is it done and what are potential risks?
The device is a highly flexible metallic implant which can be deployed percutaneously under fluoroscopic and echocardiographic guidance. Procedural risks include bleeding, perforation of the heart wall and stroke. However, those risks are statistically minimal at experienced centers and do by far not outweigh bleeding risk.